26D0671502 CLIA NUMBER - MARYMOUNT MANOR

Laboratory Demographics

CLIA Number: 26D0671502

Facility Name: MARYMOUNT MANOR

Facility Address:
313 AUGUSTINE ROAD
EUREKA, MO
ZIP 63025
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Facility Phone Number: 636 938-6770

Facility Type: Skilled Nursing Facility/Nursing Facility

Certificate Type: Waiver

NPI Number: 1598828774

Taxonomy: 310400000X - Assisted Living Facility
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

CLIA Record

Field Name	Field Value
CLIA Number	26D0671502
LAB Type	Skilled Nursing Facility/Nursing Facility
Facility Name	MARYMOUNT MANOR
Street	313 AUGUSTINE ROAD
City	EUREKA
State	MO
ZIP	63025
Phone	636 938-6770
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024